Job Search Results for healthcare payer

REMOTE EPIC SENIOR PAYER STRATEGY ANALYST

?Modeling reimbursement rates, analyzing payer performance, and delivering financial insights that directly influence contract negotiations and revenue optimization across the health system.?This... More position requires advanced analytical skills, deep knowledge of healthcare reimbursement methodologies, and proficiency in multiple financial and clinical systems.?The analyst serves as a key advisor to leadership, providing data-driven recommendations that shape payer strategy and financial planning.?Quantify payer issues and policies, monitor payer behavior, and provide analytic support during payer negotiations.?The Senior Payer Strategy Analyst will conduct ad hoc analysis and modelling, including: proposals and counter-proposals during payor negotiations, modeling new payer rates, validating incoming rate changes from payersWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Denials Specialist (Appeals & Revenue Cycle)

Insight Global is seeking a fully remote Denials Specialist to support a Healthcare AI client. This is a part-time opportunity working approximately 10?20 hours/week where candidates will leverage... More their denials and appeals expertise to evaluate and improve AI-driven denial resolution strategies. This role is highly analytical and requires a strong understanding of payer requirements, denial root causes, and effective appeal strategies across multiple payer types. Laptop and equipment will be provided.Shift Times: Flexible scheduling within Monday-Friday, 9am-8pm PST (can't work weekends)(must be available 10-20 hours/week from 9am-8pm PST // ideal for individuals seeking additional income)Duration: 3-month contract (potential to extend)Responsibilities:? Review denied claims and evaluate AI-generated denial analysis and appeal recommendations? Assess the quality, logic, and persuasiveness of AI-generated appeal strategies across various denial types (medical necessity, authorization, coding, technical, etc.)? Identify discrepancies where AI recommendations diverge from effective real-world denial management practices? Analyze and explain successful appeal strategies, including payer-specific nuances and documentation requirements? Evaluate appealability and determine optimal approach based on denial type, payer guidelines, and supporting documentation? Provide detailed reasoning behind appeal strategies to help improve AI decision-making models? Identify patterns and trends across denials to highlight systemic issues impacting reimbursement? Partner with product and GTM teams to critique presentations and provide subject matter expertise on denial workflows and payer behaviorWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Claims/EDI Representative

We are seeking a Revenue Cycle Claims & EDI Specialist to support claim submission and error resolution efforts in a fast-paced healthcare environment. This individual will work Epic work queues,... More investigate and correct registration, follow-up, and EDI-related claim errors to ensure timely claim processing and reimbursement. The ideal candidate has a strong understanding of insurance verification and payer requirements across a variety of specialties and insurance types. This is a fully remote position requiring excellent time management skills and the ability to adapt to changing daily workloads.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Remote Prior Authorization Specialist

Insight Global is seeking a fully remote Prior Authorization Specialist to support a Healthcare AI client. This is a fully remote, part-time opportunity working 10-20 hours/week where candidates will... More leverage their prior authorization expertise to evaluate and improve AI-driven authorization strategies. This role is highly analytical and requires a strong understanding of payer policies, documentation strategies, and real-world authorization workflows. Laptop and equipment will be provided.Shift Times: Flexible scheduling within Monday-Friday, 9am-8pm PST (can't work weekends)(must be available 10-20 hours/week from 9am-8pm PST // ideal for individuals seeking additional income)Duration: 3-month contract (potential to extend)Responsibilities:? Review pending authorization requests and evaluate AI-generated prior authorization recommendations and strategies? Assess the quality, logic, and effectiveness of AI recommendations across multiple payers and clinical policies? Identify gaps where AI recommendations differ from real-world prior authorization best practices and explain discrepancies? Provide detailed insights into payer-specific nuances, including portal workflows, policy requirements, and documentation phrasing strategies? Share operational knowledge with product teams to enhance AI-powered authorization processes? Partner with GTM teams to critique presentations and provide subject matter expertise on prior authorization workflowsWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Registration & Charge Error Representative

We are seeking a Patient Registration Specialist to support pre-appointment registration and insurance verification activities for a large healthcare organization. This individual will review and... More resolve registration errors, validate demographic and insurance information, and ensure patient accounts are accurate prior to scheduled appointments. The role requires working efficiently within Epic and other payer portals to prevent downstream billing and authorization issues. The ideal candidate is detail-oriented, knowledgeable in healthcare insurance, and able to manage a high-volume work queue in a fast-paced environment.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Benefit Investigation Analyst

Day-to-Day: ? Conduct patient benefits investigations and eligibility verifications with national insurance payers and TPAs? Verify coverage, deductibles, co-insurance, and patient financial... More responsibility? Serve as the primary liaison between insurance payers and the sales organization? Accurately document benefit findings and communicate details to sales representatives? Support the patient onboarding process through timely and accurate insurance verification? Respond to benefit-related questions and escalations from sales and internal stakeholders? Maintain patient records and documentation within Salesforce and internal systems? Stay current on payer policies, coverage guidelines, and reimbursement requirements? Ensure compliance with HIPAA and healthcare regulatory standards? Partner with internal operations and authorization teams to support patient access to therapyJob Description:Insight Global is seeking a Benefit Investigation Analyst for a leading medical device client. This individual will act as the bridge between national insurance payers and the sales organization, conducting detailed patient benefits investigations and eligibility verifications. The ideal candidate will have experience navigating healthcare benefits, working with TPAs and national payers, and effectively communicating coverage details to internal stakeholders. This person will play a critical role in helping patients gain access to innovative medical technology by providing accurate benefit information that enables the sales team to educate patients on coverage and financial responsibility. This is a fully remote opportunity with strong long-term growth potential.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Medical Coding Specialist (Outpatient / Profee)

Insight Global is seeking a fully remote Medical Coding Specialist (Outpatient / Profee) to support a Healthcare AI client. This is a part-time, fully remote opportunity where candidates will... More leverage their outpatient coding expertise to evaluate and improve AI-driven coding recommendations. This role is highly analytical and requires a strong understanding of outpatient coding guidelines, reimbursement logic, and payer rules across specialties. Laptop and equipment will be provided.Shift Times: Flexible scheduling to work within Monday-Friday, 9am-8pm PST (can't work weekends)(must be available 10-20 hours/week from 9am-8pm PST // ideal for individuals seeking additional income)Responsibilities:? Review outpatient encounters and evaluate AI-generated coding recommendations across settings such as same-day surgery, observation, ED, clinic, and ancillary services? Assess the accuracy and reasoning behind assigned CPT/HCPCS codes, modifiers, APC groupings, and LCD/NCD compliance? Identify discrepancies where AI-selected codes, modifiers, or APC assignments differ from correct coding practices and explain the rationale? Provide insight into coding decision-making, including modifier sequencing, bundling rules, and payer-specific nuances? Share outpatient coding expertise with internal product teams to improve AI logic and recommendations? Partner with GTM teams to critique coding-related presentations and provide subject matter expertiseWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Organizational Change Management (OCM) Consultant

A leading healthcare payor company is seeking a senior Organizational Change Management (OCM) Consultant to support a large-scale CMS Interoperability transformation initiative tied to operational... More compliance requirements. This individual will focus on organizational readiness, stakeholder alignment, business process transformation, training, communications, adoption, and change execution across multiple business and technology organizations.This is NOT a technical interoperability implementation role. Technical development is already underway. The consultant will drive the people, process, and adoption components necessary to ensure business readiness for the January 1, 2027 compliance milestone. What This Person Will Do? Develop and execute an enterprise Organizational Change Management strategy for CMS Interoperability initiatives.? Conduct change impact assessments across multiple stakeholder groups.? Build stakeholder engagement, communication, and adoption plans.? Partner with business leaders to evaluate and improve impacted workflows and operational processes.? Facilitate organizational readiness activities across Membership, Provider, Compliance, Legal, Operations, and IT teams.? Develop communication plans and executive-facing updates.? Define readiness metrics, adoption KPIs, and success measures.? Create training strategies and support organizational training rollout efforts.? Drive go-live readiness planning and post-implementation adoption activities.? Provide outside-in industry perspective and best practices around payer interoperability, prior authorization workflows, and regulatory transformation initiatives.We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Snowflake Developer (Remote)

*Fully remote, must work PST hours*We are seeking experienced Snowflake Developers to support strategic initiatives within our client?s Encounter Transformation and Medicare Advantage (MA)... More Supplemental programs. This role will focus heavily on data extraction, processing, and integration across complex healthcare systems, enabling scalable and compliant encounter submission processes.Responsibilities:? Design, develop, and optimize data pipelines to support encounter data processing and integration? Extract, transform, and load (ETL/ELT) large-scale healthcare datasets from multiple source systems? Develop and maintain scalable solutions using Snowflake, Python, SQL, and C#? Support end-to-end encounter processing workflows, including EDI, claims, and encounter submissions? Collaborate with business and technical stakeholders to translate requirements into robust data solutions? Ensure data accuracy, integrity, and compliance with healthcare payer standards and regulatory requirements? Troubleshoot and resolve data and integration issues across systemsWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less

Project Manager (Remote)

We are seeking a highly collaborative and results-driven Project Manager ? Business Operations to lead strategic initiatives across health plan operations, clinical programs, regulatory initiatives,... More and business transformation efforts. This role is focused on the business side of project delivery rather than technical implementation and will serve as the bridge between operational stakeholders, clinical teams, compliance, vendor partners, and executive leadership.The Project Manager will be responsible for planning, coordinating, and executing cross-functional initiatives that improve business performance, member experience, operational efficiency, regulatory compliance, and organizational effectiveness. The ideal candidate combines strong project management fundamentals with healthcare payer experience and exceptional stakeholder management skills. This client supports commercial, Medicare Advantage, and employer-sponsored health plans, requiring close partnership across multiple business functionsWe are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.Less